Alternative Imaging Modalities to DSA in the Acute Phase of Unruptured Vertebral Artery Dissection

Minor neck movements are a known cause of vertebral artery dissection even without any evidence of trauma. However, there are limited reports of unilateral vertebral artery dissection in a trauma patient evolving to a fatal posterior fossa infarction within one day, in the absence of any neurological deficit or a focal lesion on brain CT. We report such a case and comment on the overall efficiency of diagnostic alternatives to classic angiography that can be used in the acute phase of unruptured vertebral artery dissection. We present a case of a healthy 55 year old trauma patient with initial good neurological presentation and normal non-infused brain CT who deteriorated 16 hours following injury and deceased the following day due to a massive posterior fossa infarction and extended cerebral edema caused by vertebral artery dissection. We conclude that any trauma patient with a persistent, even mild occipital headache or neck pain can be a candidate for vertebral artery dissection. Such pathology requires both a high index of suspicion and the proper imaging modality. Vertebral artery dissection can be efficiently visualized by multisection CT angiography which is fast, accurate and non-invasive. This modality can be an alternative to classic angiography especially in emergency settings where it may not be easily available. doi:10.4021/jmc696w